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Nursing Home Survey and Certification: Assuring Quality Care Hearing

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Nursing Home Survey and Certification: Assuring Quality Care Hearing NURSING HOME SURVEY AND CERTIFICATION: ASSURING QUALITY CARE HEARING BEFORE THE SPECIAL COMMITTEE ON AGING UNITED STATES SENATE NINETY-SEVENTH CONGRESS SECOND SESSION WASHINGTON, D.C. JULY 15, 1982 14 Printed for the use of the Special Committee on Aging U.S. GOVERNMENT PRINTING OFFICE 98-!70 0 WASHINGTON: 1982 SPECIAL COMMITTEE ON AGING JOHN HEINZ, Pennsylvania, Chairman PETE V. DOMENICI, New Mexico LAWTON CHILES, Florida CHARLES H. PERCY, Illinois JOHN GLENN, Ohio NANCY LANDON KASSEBAUM, Kansas JOHN MELCHER, Montana WILLIAM S. COHEN, Maine DAVID PRYOR, Arkansas LARRY PRESSLER, South Dakota BILL BRADLEY, New Jersey CHARLES E. GRASSLEY, Iowa QUENTIN N. BURDICK, North Dakota DAVID DURENBERGER, Minnesota CHRISTOPHER J. DODD, Connecticut JOHN C. ROTHER, Staff Director and Chief Counsel E. BENTLEY LIPSCOMB, Minority Staff Director ROBIN L. KROPF, Chief Clerk (11) CONTENTS Page Opening statement by Senator John Heinz, chairman ........................... 1 Statement by Senator Lawton Chiles ............................... ............................ 3 Statement by Senator Charles H. Percy ........................................................... 5 Statement by Senator William S. Cohen ............................................................ 6 Statement by S Johnenator Melcher ........................................................... 8 Statement by Senator Charles E. Grassley . ..........................................................33 Statement by Senator John Glenn ........................................................... 71 CHRONOLOGICAL LIST OF WITNESSES Davis, Dr. Carolyne K., Washington, D.C., Administrator, Health Care Fi- nancing Administration, U.S. Department of Health and Human Services; accompanied by Daniel Bourque, Deputy Administrator, Health Care Fi- nancing Administration; and Thomas Morford, Director, Office of Standards and Certification, Health Care Financing Administration . ..................... 10 Pawlewski, Norman, Des Moines, Iowa, commissioner of health, State of Iowa, representing the Association of State and Territorial Health Officials .. 34 Simmons, Mildred Glover, R.N., Sacramento, Calif., deputy director, licensing and certification division, department of health services, State of California, representing the Association of Health Facility Licensure and Certification Directors.................................................:....................................................................... 36 Kuriansky, Edward J., New York, N.Y., deputy attorney general for medicaid fraud control, and special prosecutor for nursing homes, health and social services, State of New York ........................................................... 48 Gorrecht, Freida, Detroit, Mich., president, National Citizens' Coalition for Nursing Home Reform ............................................................ 57 Affeldt, Dr. John E., president, Joint Commission on Accreditation of Hospi- 4 tals, Chicago, Ill.; accompanied by Ralph Hall, director, long-term care accreditation program; and Paul Mullen, director, government relations ....... 75 MacDonald, Jack A., executive vice president, National Council of Health Centers, Washington, D.C.; accompanied by Laurence F. Lane, director for policy development and implementation, American Association of Homes for the Aging, Washington, D.C.; and Gailan Nichols, vice president, Ameri- can Health Care Association, Washington, D.C . ....................................................82 APPENDIXES Appendix 1. Material submitted for the record: Item 1. Illinois Department of Public Health position paper on Health Care Financing Administration proposed rules on survey and certifica- tion of health care facilities; submitted by Senator Charles H3. Percy ....... 107 Item 2. Position statement of Ruth Dear, Gray Panthers, Chicago, Ill.; submitted by Senator Charles H. Percy ........................................................... 108 Item 3. Letter from Edward C. Stec, executive director, Illinois Citizens for Better Care, Chicago, Ill., to Senator Charles H. Percy, dated July 9, 1982..............................................................109 Item 4. Letter to Carolyne K. Davis, Administrator, Health Care Financ- ing Administration, Department of Health and Human Services, from Beverlee A. Myers, director, department of health services, State of California; submitted by Mildred Glover Simmons ....................................... 110 Item 5. Region m position paper, dated March 29, 1982; submitted by Mildred Glover Simmons ................. 113 Item 6. Letter from Mildred G. Simmons regarding the CALS contract ...... 123 (1li Iv Appendix 1. Material submitted for the record-Continued Page Item 7. Memorandum to Mildred G. Simmons in connection with JCAH survey cost comparison........................................................................................ 126 Item 8. "Nursing Home Patient Abuse: Realities and Remedies," submit- ted by Edward J. Kuriansky ........................................................... 127 Item 9. Cost analysis, Iowa State Health Department versus JCAH long- term care survey, submitted by Norman Pawlewski ..................................... 209 Item 10. National Citizens' Coalition for Nursing Home Reform survey of State nursing home surveyors, submitted by Freida Gorrecht ................... 210 Item 11. Letter and enclosure from Elma L. Griesel, executive director, National Citizens' Coalition for Nursing Home Reform, to Secretary Richard Schweiker, Department of Health and Human Services, dated July 12, 1982, submitted by Freida Gorrecht .................................................. 213 Appendix 2. Letters and statements from individuals and organizations: Item 1. Statement of the American Hospital Association, Washington, D.C ........................................................... 220 Item 2. Statement of Harold Gordon, chief, division of licensing and certification, Maryland Department of Health and Mental Hygiene ........ 222 Item 3. Statement of the American Bar Association Commission on Legal Problems of the Elderly ................. .......................................... 223 Item 4. Letter and enclosure from Martin A. Janis, director, Ohio Com- mission on Aging, to Senator John Heinz, dated July 27, 1982 .......... ........ 227 Item 5. Statement of the Service Employees International Union, AFL- CIO/CLC, Washington, D.C ........................................................... 229 Item 6. Statement of the American Nurses' Association ............... .................. 231 Item 7. Letter from Peter W. Hughes, legislative counsel, American Asso- ciation of Retired Persons, to Senator John Heinz, dated August 10, 1982 ........................................................... 233 Item 8. Letter and enclosure from Patricia Nemore, staff attorney, Na- tional Senior Citizens Law Center, Washington, D.C., to Senator John Heinz, dated August 12, 1982 ........................................................... 235 NURSING HOME SURVEY AND CERTIFICATION: ASSURING QUALITY CARE THURSDAY, JULY 15, 1982 U.S. SENATE, SPECIAL COMMITTEE ON AGING, Washington, D.C. The committee met, pursuant to notice, at 9:32 a.m., in room 5302, Dirksen Senate Office Building, Hon. John Heinz, chairman, presiding. Present: Senators Heinz, Percy, Cohen, Grassley, Chiles, Glenn, Melcher, Bradley, and Burdick. Also present: John C. Rother, staff director and chief counsel; E. Bentley Lipscomb, minority staff director; Becky Beauregard, deputy staff director; Ann Langley, professional staff member; Kate Clarke, director of communications; Bill Halamandaris, direc- tor of oversight; David Holton, chief investigator; Kathleen M. Deignan, minority professional staff member; Robin L. Kropf, chief clerk; and Angela Thimis, staff assistant. OPENING STATEMENT BY SENATOR JOHN HEINZ, CHAIRMAN Senator HEINZ. Today, the Senate Special Committee on Aging is meeting to review the serious concerns many of us have and have expressed about the regulations affecting nursing homes that were recently proposed by the U.S. Department of Health and Human Services. Assuring the delivery of quality care to our Nation's 1.3 million nursing home residents is a responsibility which the Federal Gov- ernment assumed more than a decade ago, and the other members of this committee and I have been deeply committed to making cer- tain that this responsibility is met. The Federal involvement with nursing home care has taught us two very important things. First, the delivery of quality care re- quires the development of basic health, safety, and staffing stand- ards. Second, it is essential to structure monitoring and enforce- ment mechanisms to guarantee adherence to these standards. It is clear that Federal standards and enforcement procedures currently on the books have brought about significant improve- ments in the care of nursing home residents. But we still hear, too frequently, of instances of neglect, abuse, and substandard care. We know that the present enforcement program is plagued by in- adequate funding, bureaucracy, and redtape. We know we must do better. (1) 2 On May 27, the U.S. Department of Health and Human Services issued proposed regulatory changes to the nursing home inspection program. I have given these proposals very careful consideration; and, regrettably, I have concluded that they will seriously reduce Federal and State oversight capabilities. I believe they will strip the nursing home inspection program of its ability to monitor and enforce
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